Low Back Pain - Ask Dr. P

How Pulsed EMF and Red Light Can Help With Low Back Pain

by Pain Doc | Nov 29, 2021 | Low Back Pain

Low back pain affects nearly everyone at some point in their lives. Medical researchers have long known that most cases of low back pain self-resolve after a couple of days with rest and palliative measures such as application of hot packs and cold packs.

But for some, low back pain returns, and eventually becomes chronic. “Chronic” means that pain has reached a level where tissue healing has for the most part completed, but there is recurring pain. Chronic pain is usually characterized as dull, persistent pain; as opposed to the sharper acute pain, which is the type of pain associated with recent injury or major aggravation of a previous injury; characterized by heat, redness and swelling. Chronic pain is believed to be central nervous system driven; meaning that some of the pain signals are emanating from brain and spinal cord neurons as opposed to nociceptors, the special pain-sensing fibers found throughout your joints, tendons and muscles.

If you have acute low back pain– again, from a recent injury, or aggravation of a previous back injury resulting in swelling and pain, the standard protocol agreed to by most orthopedic specialists is rest, ice for the first two days, followed by an optional hot pack for the next 3-4 days. “Rest” doesn’t mean bed-ridden. When used in this context, rest means no heavy lifting, bending at the waist, or activities that place undue pressure on the spine such as running or jumping. However, you should move your body in ways you can; i.e. do not mentally “catastrophize” it because studies show that this mindset can actually lead to poorer outcomes, such as taking a much longer time for the pain to resolve, and atrophy of the back muscles which reduces support to the spine and therefore predisposes it to further injury.

If you have chronic low back pain, the goal is to manage it so that it has a minimal effect on your activities of daily living– standing, sitting, walking, bending, and other activities that require similar use of the spine. If your chronic pain is mostly central nervous system in origin, it would be worthwhile to practice mind-body techniques. This includes yoga, meditation, and practices of that nature. Having control of your thoughts can be helpful in controlling chronic pain. It’s not all about ignoring your pain, but rather, not amplifying it by mentally embracing and validating it. The best approach is to continue as best as you can with your regular life activities– the things you did before the injury event. Modify them to accommodate any physical limitation, if necessary. For example, if you used to run, try speed walking. It’s less jarring to the knees and low back, and you burn the same number of calories. What’s most important is getting out there and staying active; i.e. “move through the pain.”

You can of course try to alleviate acute or chronic low back pain by using certain modalities. The ones I recommend are red light therapy and pulsed electromagnetic field therapy. Red light (emitted by a light emitting diode, or LED) has a wavelength range of around 660 nanometers. It is electromagnetic energy at a wavelength that can influence biological activity in a positive way. Studies show that light at this wavelength gets absorbed by cell mitochondria, which respond by becoming more active. Mitochondria are the parts of a cell that extract energy from ATP, the molecule synthesized from glucose (sugar) in the diet. A recent study showed that applying red light to your eyes in the morning can even improve eyesight. If you have an injury and/or inflammation, red light therapy can be helpful in accelerating the healing rate.

If the original injury event was within a year, it is possible to eliminate your chronic pain and have it never come back again. You see, in some cases of ongoing pain, it could be that your injury still has the potential to completely heal but it just needs a boost on energy. Cells are dormant or at a low energy state and there is not much activity going on; i.e. protein (collagen) synthesis and cell division/ new cell creation. Here’s where Pulsed EMF can help. Pulsed EMF, known as “energy” medicine, is the only modality that works by increasing the action potential of cells. Like voltage that drives electrical current, a strong action potential across a cell membrane will enable the cell to improve its metabolic rate. Nutrients and oxygen will move across the membrane into the cell, while waste products and CO2 will efficiently exit the cell through the membrane. When the cells are more energized, their healing capacity increases.

To further enhance healing of an old injury, apply 30 minutes of Pulsed EMF twice a day, followed by ten minutes of red light therapy. What’s great is that you do not need to be a licensed doctor to acquire these modalities. They are safe enough to use at home and there are no studies that show a harmful or negative effect in the use of these machines. If you wish to get out of pain sooner and in the long run, you can’t go wrong with Pulsed EMF and Red Light therapy. When combined, they serve as a powerful treatment for injuries and pain.

Pulsed EMF and Red Light also can serve as maintenance therapy for those who have no health issues. Living in a modern society, our cells and tissues are constantly exposed to unnatural and even harmful electromagnetic fields from things like cell phone towers and powerful transformers in buildings (Pulsed EMF generates EM fields with the same frequency and wavelength profile as those naturally produced by the body itself, at higher amplitude). This saps our energy and weakens and drains cell energy. Applying pulsed EMF re-energizes the body very much like how you recharge your cell phone battery every day. Your body will feel the difference with the energy boost Pulsed EMF provides.

Two Modalities to Heal Low Back Pain in Half the Time

by Pain Doc | Oct 20, 2021 | Low Back Pain, Pulsed EMF, Red light therapy, Self Treatment

Hey, I know there are millions of pages on the internet on how to fix low back pain. It can be a dizzying experience searching through them. It’s information overload.

I began blogging on this site around 2010, but actually have been writing articles on things like exercises for low back pain, neck pain, sprains and strains and so forth, since about 1994 when the internet was in its infancy. Fast forward 28 years, and now there are tons of articles and videos online, including mine. Much of the online content for treating low back pain is good: well-written, easy to understand and follow, and backed by evidence. Others are mediocre; just a re-hash of old-school approaches to treating back pain (rest, ice, no heavy lifting, etc.).

If you know me, when it comes to teaching others how to self-treat pain, I like to write fresh, interesting and innovative content. I figure that there are more than enough good videos on stretching and exercising for low back pain. What I like to do is explain the etiology of pain and propose interventions to prevent that pain from developing or getting worse.

If you have acute (recent onset) low back pain, research shows that in most cases, it will go away on its own if you just take it easy for a couple of days. Sure, icing, applying hot packs and no heavy lifting are obviously recommended to prevent re-aggravating the condition. The problem is that most people can’t afford to wait that long, and don’t like being in pain. They have a job, they have responsibilities to other people, and, they want to have fun and do the things they want to do.

For these individuals, there are a couple of home therapies I recommend, to shorten the healing time.

When you have low back pain, muscles and ligaments in and around your spine are generating pain. Something was disrupted mechanically, and inflammation is going on – blood vessels are releasing histamine and heparin and the inflammatory cascade is active—heat, redness, swelling, pain. The inflammatory chemicals irritate sensory nerves, causing some of the pain; as well as the pressure from the swelling. The nerves themselves may be over-firing; generating a level of pain that is not really proportional to the amount of tissue injury.

So with that, my go-to home therapy is a combination of Pulsed EMF and Red Light. Pulsed EMF is an externally-applied, pulsed electromagnetic field. The field, which is similar in frequency to the body’s own natural EM fields, passes through your body and essentially energizes the membranes of cells.

Cell membranes let things in and out of the cell, especially synthesized proteins, nutrients, oxygen, and waste products. They do this via active and passive transport, which both rely on membrane potential—a weak voltage created by negatively charged ions on the outside of the cell, and positive ions on the inside. Like how a battery’s voltage can power a light bulb, a cell’s weak voltage along its membrane powers the exchange of molecules in and out of the cell.

When cells (in this case muscle, bone, nerve, blood vessel cells) are physically damaged or weakened, this exchange is hampered and the tissues are slow to recover and return to a normal, non-pain state. Pulsed EMF lends a boost to this energy, helping cells become more robust in their healing and recovery activities.

Red Light therapy also can energize weak cells, but via photobiomodulation. Cells absorb red light in the 660-720 nanometer wavelength (electromagnetic energy), due to their molecular composition. Photons strike the nucleus, mitochondria and membrane, which changes the oxidative state of the cell. When this happens, it triggers cell signaling pathways related to metabolism and energy production. The cells increase their ATP output, which gives them more energy to repair damaged sites and synthesize needed repair proteins.

Pulsed EMF devices for home use are very easy to operate. Usually, it’s a matter of just pressing the power button, and sometimes a Mode button and Timer button. One of the better models is the BioBalance. You can order it with a full body mat, or a pad. Simply find a comfortable place in your home such as your sofa; place the mat on it, and lie down so that your low back is directly over the mat. No need to remove clothing; the pulsed EMF field passes right through. Do it 3x day for 20-30 minutes/ day to help your body heal and recover.

Another option is the OMI full body PEMF mat. It is lower power than the BioWave, but sometimes that works just as well, as the EM fields are very subtle. You don’t want fields that are too strong. Remember, your body already produces weak magnetic fields; you just want to complement them with a boost of comparable energy.

Red Light therapy is also a great investment in your health. I recommend getting a red light LED wrap, or LED panel. The wrap is a flexible pad embedded with red light LEDs emitting red light and infrared light (660, 820 nm). The red light diodes create photobiomodulation while the infrared diodes provide deep penetrating heat to dilate blood vessels and increase oxygen delivery to cells.

Red Light panels come in different sizes. The small ones are popular for treating facial skin conditions and beautification. The larger panels are better for treating pain. You can mount or hang the panel on the wall, and position yourself so that you are exposed to the red light (usually requires standing up).

In summary, if you are prone to getting lower back pain or have chronic pain issues, Pulsed EMF and Red Light Therapy are two, powerful and safe modalities that can be used at home for self-treatment and are easy to operate. Best of all, they have a long history of medical research to support their use in treating pain and healing injury. It does require a modest investment, but what is more important to your health and well-being? Without this, nothing else matters.

The 30 Day Pain Relief Challenge Kick Off

by Pain Doc | Jan 4, 2021 | Foot and Ankle Pain, Hand and Wrist Pain, Hip Pain, Knee Pain, Leg Pain, Low Back Pain, Neck Pain

It’s 2021 and time to kick off the 30 Day Pain Relief Challenge!

But first I want to acknowledge what’s on everyone’s mind.

2020 began with an unexpected crisis, the COVID-19 pandemic. A new corona virus strain emerged; highly contagious and deadly for certain individuals, and for which there was no vaccine. As of this writing, over 85 million people worldwide have contracted the virus, with 1.85 million dying from it. The United States is being hit the hardest, with 20.8 million cases and 352,000 dead. The numbers are expected to spike following the holiday season, thanks to many people choosing to get together in large groups and ignoring the risk. So please, remain extra vigilant the next two weeks because chances are, there are more viruses around you than there were a month ago, ready to find a new host.

As we navigate through COVID-19 in 2021, life must still go on. I know many have been hurt economically, and their number-one priority is to find a way to get back on their feet. It is not an easy thing to do, especially if you lost your job and the life skills you possess are in an industry that has been permanently impacted by the pandemic. If this describes your situation, I sincerely hope you find a way to re-position or re-invent yourself, to get back to earning a living.

While COVID-19 dominates the news and peoples’ attention, we must not lose focus on the many other challenges life presents that also need our attention. How would you rate your health at the start of the new year? How about your energy levels and endurance?

Quarantining and social distancing have a way of discouraging exercising and promoting over-eating, a terrible combination to health. When one is restricted from going outside and going to a gym (although a gym is not necessary for staying fit, but I digress…) and constantly bombarded by news of doom and gloom, the tendency is to stay home, surf the web, and eat, more than you typically do (what else is there to do in such a scenario?). And for many, the choice is high-calorie comfort food. This can lead to unwanted weight gain, muscle atrophy, joint pain, and so on.

If you are not feeling 100%, then I encourage you to open all the emails I’ll be sending over the next 30 days—the 30 Day Pain Relief Challenge is about to kick off, and email is how it will be executed.

And what exactly is the challenge? It’s about challenging yourself to get out of your comfort zone and do all the things I will suggest in the coming days so that you can get out of pain, or significantly knock it down to levels you haven’t experienced in a long time.

The other reward may be that you will lose 10 pounds or more; will have more energy, and will notice that your mind/ thinking is clearer. This is because the methods I’ll go over target your body and all its systems; not just the area of pain. It is wholistic.

But first let me explain how you will be measuring your results. After all, pain is subjective. You need some kind of tool to quantify your improvement, so read on.

Pain, aches, discomfort or whatever you want to call it affects your health. There is mental health and physical health; both important to happiness in different ways. Your physical and mental health are impacted, even just a little and perhaps unnoticeable to you, if you have chronic pain/aches/discomfort. Less-than-optimal physical and mental health impacts quality of life. Quality of life in this sense refers to your ability to physically do what you need or want to do; whether it be your job; recreational activity such as playing golf or swimming; or activities of daily living; i.e. taking care of yourself and your personal needs.

Why You Might Have a Disability if You Have Pain

If you live with chronic pain, you likely have some degree of disability.

“Me disabled?” you might be thinking. “No way!”

The word “disability” is often misconstrued. Disability doesn’t necessarily mean “disabled” and in a wheel chair. It simply means not being able to perform a certain task without some degree of difficulty or impediment; or not being able to do it at all.

Doctors (medical examiners) who issue disability certificates or write medical-legal reports are tasked to determine the degree to which someone is disabled. Their findings determine the patient’s disability compensation from the insurance company or government agency. They use observation, physical exam procedures, diagnostic tests like X-rays and nerve conduction; and instruments to measure strength, pain perception, reflexes, coordination, and range of motion. Any deficiency is expressed as a percent disabled, and there are laws that define levels of disability.

For example, in the insurance industry, the loss of both eyes, or the loss of two limbs equates to “100% disability.” Not being able to maintain a tight grip could be rated as 20% disability if the person’s occupation requires power gripping machinery.

Disability can also be subjectively quantified using Disability questionnaires where the patient rates his/ her ability to perform certain tasks on a scale of zero to some number; and the level of pain. In some questionnaires, the zero rating means you have zero difficulty doing the task (best score), while in others the zero rating means you cannot do the task at all (worst score).

For example, the following is one section of the Oswestry Low Back Pain Disability Questionnaire. Imagine having low back pain and rating yourself (0 to 5) on your ability to lift things:

LIFTING:

0 – I can lift heavy weights without extra pain

1 – I can lift heavy weights but it gives extra pain

2 – Pain prevents me from lifting heavy weights off the floor, but I can manage if they are conveniently positioned, i.e. on a table

3 – Pain prevents me from lifting heavy weights, but I can manage light to medium weights if they are conveniently positioned

4 – I can lift very light weights

5 – I cannot lift or carry anything at all

When rating yourself, you must try to be as objective as possible—don’t over rate your ability; nor under rate it. Give each question some thought.

Then, you add up the numbers, divide it by the total number of points and multiply by 100 to get a percentage score.

If the zero rating is assigned to “full ability to do the task” (like the Oswestry above), then the score is interpreted as “percent disabled.” So, an individual with no low back disability whatsoever will score zero out of 50 and his rating will therefore be zero percent disabled; i.e. 100% functional. If his score is 30, then 30/50 x (100) = 60% disabled.

Below is an example of an Oswestry Low Back Pain Disability Questionnaire completely filled out:

oswestry low back pain disability questionnaire

In the above example, the total points out of all ten questions is 19, which is considered a Moderate disability, out of No, Mild, Moderate, Severe and Total Disability. In this case, 19/50 x 100 = 38% disabled due to low back pain. Now this person has a baseline for his condition, and can set goals to lower it each time; perhaps to 20% after a month, then 10% after three months of therapy.

If the zero rating is instead assigned to “no ability to do the task,” the score is interpreted as “percent functional.” This is how the Upper and Lower Extremity Disability questionnaires are designed. So a score of zero in this case means zero percent functional (totally disabled), and 30% means you are 30% functional (you lost 70% function in that limb).

Please note that Disability questionnaires are used as tools to quantify and set baselines for pain and functional capacity; your scores do not officially establish any disability you may have, they simply provide a more tangible interpretation of pain.

Quantifying pain/disability, even if subjective, gives you a sense of how significant it is; i.e. how much it affects your life. Secondly, it can be used as a tool to measure your improvement over time, after doing some therapy and/or rehabilitation (strength and coordination exercises). This lets you know if what you did works for your condition, and therefore, whether to continue or discontinue it.

For example, if your baseline Oswestry score was 60%, and you were prescribed some McKenzie exercises for one week and a follow- up score was 40%, it suggests that those exercises improved your condition and you should continue or progress to the next level. If it was 60% or higher, you should discontinue the exercises and try another approach.

You don’t have to see a doctor to use Disability questionnaires to subjectively assess your disability. They are fairly straightforward to use and you can download the forms from the internet (see below; I’ve done it for you).

Determine Your Pain/Disability Baseline

If you have low back pain, neck pain, shoulder pain, or lower or upper limb pain then I suggest monitoring your condition using the appropriate disability questionnaire. If you are getting therapy, your doctor should be having you fill these forms (or something similar) out each visit and going over the results with you. It’s substandard care if you don’t know if the therapy you are getting or exercises you are doing is helping; these questionnaires will prompt you to think about the change or lack of change in your functional capacity, and will help you assess your care so that you can take appropriate action.

Below you will find forms to assess any musculoskeletal pain you are having. If you wish to participate in the 30 Day Pain Relief Challenge, print out the appropriate disability questionnaire; rate your abilities as objectively as you can and calculate your score; set it aside, and be ready to fill out a new questionnaire after 30 days of diligently doing the things I will cover over the next 30 days.

My goal is for participants to experience at least a 50% improvement in their pain/ disability scores. If you have any friends who might be interested in participating, please refer them to my site, https://PainandInjuryDoctor.com and have them enter their email in the opt in form.

Download the Low Back Pain Disability Questionnaire

Download the Neck Pain Disability Questionnaire

Download the Shoulder Pain and Disability Index Questionnaire

Download the Upper Extremity Disability Questionnaire

Download the Lower Extremity Disability Questionnaire

What Causes Low Back Pain?

by Pain Doc | May 29, 2020 | Low Back Pain

Low back pain continues to be a problem for many people. If not you, then most likely several people you know: neighbors, co-workers, friends and relatives. That’s what the statistics tell us.

Since it is so prevalent throughout the world, “what causes low back pain?” is a question millions of people want answered. Is it normal and expected as we age? Is it genetic? Will you need to get surgery? As you can expect, the answer is different for different people. First of all, the pain is not identical from person to person. Some people get low back pain on the right side; some get it on the left side. Some get low back pain into the hip.

In this post, I will do my best to help you understand what causes low back pain and at the end of the article provide you a tool to pinpoint what is causing your particular low pain.

The Lumbar Spine and Its Significance

Your low back or lumbar spine engineering-wise is your body’s lynch-pin– along with your pelvis, it connects your upper body to your lower body and is tasked with balancing and moving your torso. If you injure your low back it can put you out of commission: any attempt at moving places a load on your low back and makes pain worse. In extreme cases it is even painful to take in a deep breath! Acute low back pain can instantly stop a 250 pound football player in his tracks; that’s the power it has.

While most cases of low back pain self-resolve over a few days, about 20% of them become chronic, or recurring. For some, it strikes every couple of months; for others, it’s enough to impede their daily activities and quality of life. In fact, low back pain is said to be the number one reason for lost work days (disability) in industrialized nations, and therefore lost productivity.

The reason why low back pain is so prevalent is a societal phenomenon, made possible by evolution. You see, humans are the only bi-pedal animal on the planet. Dancing bears and meerkats don’t count because although they can walk a few steps their pelvic design is still quadri-pedal (walking on four limbs). When nature selected homo sapiens to be bi-pedal, it freed up his arms to carry things–heavy things. Carrying and lifting things and bending the low back places a tremendous load on the lumbar spine, and like any machine, the components bearing the most stress will be the first to break down.

Secondly, the invention of the chair and desk. When our ancient ancestors roamed the plains and forests 30,000 years ago there weren’t any chairs around to sit in for hours, placing pressure on the low back and weakening the postural muscles of the spine. Today, many jobs require sitting at a desk in front of a computer, doing just that. Also, food these days is abundant and much less nutritious causing humans to gain excess weight, placing constant stress on the low back throughout the day.

Causes of Low Back Pain

The vast majority of low back pain cases are mechanical in nature; meaning caused by a breakdown of some physical component of the lumbar spine. These components are the muscles, fascia (muscle sheath), ligaments and tendons; vertebrae, vertebral joints, and discs (which are technically ligaments). If the dysfunction causes compression of nerve roots, then nerve pain is involved, which usually means shooting / radiating pain and/ or numbness down the buttock to lower extremity; sometimes as far down to the sole of the foot.

Here are the main categories of mechanical low back pain:

Congenital Malformations

Sometimes there are abnormalities in the development of the spinal column which interfere with proper movement and balance placing excess stress on soft tissues and sometimes nerves, generating pain or constant stiffness and aches, and loss of range of motion/flexibility. Examples include fused vertebrae (two adjacent vertebrae fused together instead of forming a joint); scoliosis; spina bifida, pars defect, hyperkyphosis (hunchback); and hyperlordosis (swayback).

Injuries

Low back pain is often due to injuries to tissues: sprains to ligaments; ruptured intervertebral discs from a herniated or prolapsed nucleus pulposus (jelly-like shock absorbing substance in all discs); strains (tears, small and large) to muscles and tendons; muscle spasms, and fractures. These can be traumatic from a specific incident such as a sports injury, or can be cumulative over time, often years, from performing a certain movement repeatedly or sitting/slouching causing gradual degenerative disc disease. With acute tissue injury, the inflammatory response is initiated, which is responsible for the pain generation.

Degenerative Changes

Joints wear out over time. Most doctors will tell patients their condition is from “normal” wear and tear. But that’s not accurate. For some people, joints deteriorate at an abnormally fast rate, mainly due to lifestyle factors under their control. I’ve seen X-rays of 60 year-olds look much better than 30 year-olds, on many occasions.

Factors that promote lumbar spine degeneration include:

Being overweight
Genetic predisposition
Sedentary lifestyle/ lack of physical activity
Sitting frequently (airline pilot, police officer, truckers, data entry)
Heavy labor job
Contact sports, especially football
Occupation or recreation that involve hard landings (basketball, gymnastics, parachuting, etc.)
Previous injuries/accidents such as falls and car accidents
Poor diet (your body needs proper nutrients to heal tissues)
Smoking (smoking reduces oxygen to cells and may trigger inflammation)

Doctors use three terms to describe spinal degeneration:

Spondylosis when referring to the vertebrae as a whole;
Degenerative joint disease or DJD if referring to the vertebral joints: facet joints and intervertebral joints; and
Degenerative disc disease or DDD if referring to the intervertebral discs

In all cases, the joint surfaces of the vertebrae lose their smooth borders and form jagged bone spurs called osteophytes. You can have a lot of osteophytes in your spine and not feel pain at all. In fact, if you are over age 40 you probably have them yourself. But if the osteophytes get big enough to narrow the openings where nerves pass through, called foramen, problems start. This narrowing of the foramen is called spinal stenosis and can occur with the intervertebral foramen (IVFs), the small holes formed by adjacent vertebrae which nerve roots pass through; and also the central canal where the spinal cord and cauda equina reside. This can lead to shooting pain down one or both legs; numbness and tingling in the legs, and leg muscle weakness, atrophy and loss of sensation.

Since osteophytes do not resorb (shrink) and only get bigger with time the only option is spinal decompression surgery which involves shaving off the osteophytes to make more room for the nerves.

And there is another problem: when spinal discs degenerate, they lose height (this is part of the reason why most people get shorter as they age). A healthy L5-S1 disc can be in excess of 1 cm thick while a degenerated one can be just 2-3 mm thick. When this happens, the posterior and anterior longitudinal ligaments that run down the front and back of your vertebral column slacken, or buckle, at those levels. Like osteophytes, buckled ligaments can cause stenosis, compressing or irritating nerves and causing the same neurological symptoms.

When the degenerative changes involve deterioration of cartilage, you have bone on bone contact. The cartilage in your spine is located in the encapsulated facet joints, located behind the vertebral bodies. This triggers inflammation, which leads to osteoarthritis. It’s the same process as osteoarthritis of the knees and hips, occurring in the spine.

Like knee osteoarthritis, people with spinal OA will feel burning pain in their lumbar spine especially when standing, and stiffness which is worse upon waking in the morning. Osteoarthritis is a chronic, degenerative disease that is best managed by lifestyle modification (anti-inflammatory diet, exercises, stress reduction). Those with severe cases sometimes elect to use prescription anti-inflammatory medication.

Non-Mechanical Causes of Low Back Pain

Less than 1% of low back pain cases are due to other factors, most of which are “red flag” cases that require immediate medical attention. These include pelvic tumors, kidney stones, metastatic cancer (usually from prostate cancer), infection, and endometriosis. A brain tumor is capable of causing sciatica-like symptoms if it affects the sensory neurons that go to the leg. While rare, if you have low back pain that does not improve with physical therapy or rest, it is a good idea to see your doctor and get some tests done to rule out these conditions.

Summary and Main Take Aways

If you have low back pain, chances are very good it will go away with rest. Apply ice for the first 1 to 2 days. If severe, you can try taking over the counter anti-inflammatory medications (NSAIDs) such as Motrin or Ibuprofen to knock down some of the pain. And if you are lucky to have a cryotherapy center near you, you can do a couple of visits to shorten the healing time.

If the pain lasts more than 4 days, then it usually means something is perpetuating it: perhaps you are not resting it properly; are re-aggravating it; or have some kind of contributing factor such as a rotated vertebra or disc protrusion. These issues can be dealt with by visiting a good physical therapist or chiropractor. You can even do some home exercises and home therapy for low back pain on your own and still get great results.

While most cases of low back pain go away, it doesn’t mean that it will stay away for the rest of your life: 20% of people who get low back pain will experience it again in the future; either from a new injury/event or a flare-up of a pre-existing injury. And remember, some cases become chronic (pain decreases, but the improvement plateaus and remains, with some days worse than others). Your prognosis will depend on what is causing your low back pain (see below for a self-diagnosis tool) and other factors related to your medical history and daily activities.

When dealing with low back pain, besides focusing on reducing the pain think of what things caused it and eliminate those causes as best you can. It may mean:

Getting a stand up desk (standing puts less stress on your low back than sitting)
Losing some weight
Eating a healthier diet
Stopping smoking
Exercising more often
Reducing emotional stress in your life
Improving the ergonomics of your work station
Learning how to lift properly
Getting your back adjusted by a chiropractor periodically to improve joint movement and joint health

And lastly, remember that low back pain should noticeably and progressively improve each day after initial onset. If you notice that pain does not get better with rest, express your concern to your doctor: demand an X-ray, MRI and/or a blood test. Red flag cases like cancer are often misdiagnosed by doctors (dismissed) as general back pain due to spasms because doctors know that the medical literature estimates red flag cases to be 1% or less of all low back pain cases. Remember to be persistent; it is your life you are dealing with.

Below is a low back pain algorithm I created to help you diagnose your particular low back pain so that you can take appropriate action. Use the top one if your low back pain onset was sudden; use the bottom one if the onset was gradual. This is only a guide; always check with you doctor who can examine you, to get an accurate diagnosis.

How to Do Home Traction for Low Back Pain

by Pain Doc | Feb 23, 2017 | Low Back Pain

Lumbar traction is one of the things you can do to manage low back pain yourself, and not have to spend $$ on the chiropractor or physical therapist.

It involves stretching the lumbar spine in the axial plane; i.e. length-wise; causing slight separation between the vertebral bodies and smaller facet joints. The traction force has to be strong enough to overcome the resistance from muscles and ligaments in order to derive benefit; otherwise it’s just a muscle stretch.

Why Your Height Changes Throughout the Day

Do you notice how you have to adjust your car’s rear-view mirror in the morning in order to align it properly with the rear window?

That’s because you are sitting higher in the morning, and are actually taller; perhaps a full centimeter.
When you stand or sit throughout the day, the force of gravity compresses the discs in your spine; mostly the thick ones in your low back (lumbar). At the end of the day, the discs are slightly thinner due to this constant pressure, and you are shorter. If you drive your car around this time, you probably don’t notice that you have to adjust your rear-view mirror downwards.

When you sleep, you are in a horizontal position and the effect of gravity on your discs is reduced. As you sleep, your discs slowly re-hydrate themselves, like a dry sponge soaking up water, and you become taller overnight!

Most of your upper body’s weight is supported by your lumbar spine, or low back. That’s why the lumbar vertebrae and discs are the thickest and strongest in the spine (compared to those in the neck and torso). The discs/vertebral bodies absorb 80% of the weight placed at that level; the two facet joints behind the vertebral body bear about 10% each.

As you age, your lumbar discs lose some of their ability to resorb fluids. That is one reason you tend to get shorter as you reach 60 and beyond. Like a car tire or other moving machinery part, its function degrades over time.

Factors that accelerate disc wear and tear are being overweight; having an occupation that requires prolonged sitting (desk job, truck driver, airline pilot, etc.); injury to your low back in sports or an accident; and having parents who had back problems.

If any of these describe you, then definitely try doing home lumbar traction periodically. If you currently have low back pain, traction can alleviate some of it by reducing pressure to your discs and facet joints, which do have nerve endings. If you don’t have low back pain, traction can be done to help prevent your discs from degenerating; or at least arrest the progression of disc degeneration. This can save you from major back problems in the future; perhaps even surgery.

What are your home traction options?

The most effective traction is done by the professional equipment used by chiropractors and physical therapists. Sometimes referred to as “non-surgical spinal decompression,” it basically involves lying prone or supine on a special table that has a movable lower section that glides on rails.

You are secured to the table by some contraption, and a harness is placed around your pelvis. A cable connects the harness to a special motor, which can be programmed to pull in different patterns.

For example, there can be settings for frequency of pulls per session; strength of pull; duration of hold time; and pull patterns (step up, step down, constant, variable). The machine must be able to overcome guarding (involuntary contraction) of the erector spinae muscles of the lumbar spine, which are quite strong by the way, so that the traction affects the spinal discs and joints which start to separate only after the back muscles let go.

Now, if you want to get this level of traction you have to find a center that offers this and make an appointment.

Consumer-level home traction devices are entirely different. Most of them leverage your own body’s weight to do the traction.

Watch this video, as I review four devices that can be used for lumbar traction:

The four home traction devices I discuss in this video are the inversion table, the Back Bubble, the Stamina traction device and the PosturePump™ elliptical spine trainer. All have their advantages and disadvantages. If you want to give home traction a try, watch the video and do further research.

In summary, home lumbar traction can be a comparatively low cost approach to managing general low back pain, and a great preventive measure. Traction helps relieve pain by decompressing discs and facet joints, and assisting them in re-hydration, especially at the end of the day.

How to Self Treat Sciatica- Radiating Nerve Pain in Buttock and Leg

by Pain Doc | Aug 27, 2015 | Low Back Pain

Most cases of sciatica involve a bulging disc in the low back pressing on the S1 nerve root, left or right side; less commonly on both sides. The S1 nerve root is one of several that form the sciatic nerve, the largest/ thickest nerve in the body that controls muscle contraction and sensation in the legs.

The S1 nerve root may also be pinched by a thickened spinal ligament or an osteophyte (bone spur) in the foramen (hole) where the nerve comes out of the spine (notice the left vertebrae in the image below demonstrating this).

verteb

Sciatica can also arise from tight muscles in the buttock (hip rotator muscles) squeezing it. If you had a fall or injury that misaligned your sacrum, lumbar spine or hip joint it could throw those butt (gluteal) muscles out of balance, causing them to scissor the sciatic nerve where it passes between these muscles.

pirifomis

Lastly, the worse kind of sciatica is from spinal stenosis. This is when the central spinal canal in the lumbar spine narrows, pinching the nerves that lead to the legs. The canal narrows due to degenerative joint disease in the lumbar spine. Some people in this group walk in a crouched forward position, because it seems to provide relief.

Treating Sciatica Yourself

If you have some low back pain along with sciatica, or a history of it, chances are your sciatica is due to a bulging disc. The strategy then is to reduce the bulging disc; i.e. decrease its size so that it doesn’t pinch the nerve.
Lumbar extension exercises at various angles can be helpful in reducing bulging lumbar discs. The key is to find the right angle, as all disc bulges don’t behave the same in response to certain movements. The correct movement causes the lumbar vertebrae to “pinch” the bulge back to center. Watch this video where I demonstrate how to do this.

You can also use the PosturePump. This is a device that extends the lumbar spine in the non-weight bearing position (while lying down).

If your sciatica is caused by pinching of the sciatic nerve in the buttock, try stretching your gluteal muscles (piriformis) muscle to lengthen it. There are several ways to do it. One is to cross your legs while sitting (bad leg on top), clasp your hand over the top knee and bend forward as far as you can go (may be difficult if you have a large belly). Hold for about 15 seconds; relax. Repeat 6 times twice a day.

You can use a power massager like the Max2 Percussion massager to “shake” the spasm out of the piriformis muscle. Watch this video where I demonstrate this technique.

If you have canal stenosis, and your symptoms are unbearable, get a consultation from a spinal surgeon on your options.

Sciatica often affects those who sit frequently, for long hours. Sitting places a lot of pressure on the discs and promotes bad posture. It also places pressure on the sciatic nerve, especially if you don’t have much fat in the buttocks for cushioning and if you have a hard chair. Wearing a thick wallet in your back pocket can cause more pressure to the nerve.

One of the best ways, in my opinion, to reduce the bad effects of sitting is to use a stand up desk. Many employers will pay for this, since studies are coming out showing how prolonged sitting damages health over time. The VariDesk is an affordable option for a standing desk.

standing_desk

Other considerations

-Get good shoes with arch support. This alone may ease your sciatica.
-Strengthen your low back, hip and butt muscles by doing kettlebell swings.
-Seek out an Active Release Technique (ART) practitioner. This is a special massage designed to normalize muscle contraction and joint movement.

If you have a history of injury involving your low back and/or pelvis, get checked by a chiropractor. Chiropractic adjustments can re- position the area, removing abnormal pressure to muscles and nerves.